显微镜辅助下经椎间孔椎间融合微创治疗腰椎退变性疾病的临床疗效比较

doi:10.3760/cma.j.issn.2095-7041.2018.03.005

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摘要目的探讨显微镜辅助下经椎间孔椎间融合微创手术(MIS-TLIF)治疗腰椎退变性疾病的临床疗效及安全性。方法回顾性分析2016年1月—2017年1月空军军医大学西京医院骨科160名腰椎退变性疾病患者的临床资料,其中80例行开放经椎间孔椎间融合术(TLIF)为对照组,80例行显微镜辅助下MIS-TLIF为观察组。对比两组患者手术前后腿痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、手术时间、手术切口长度、术中出血量、术后引流量、X线照射时间、术后椎间植骨融合率以及并发症情况等。结果观察组和对照组患者手术切口长度分别为 (3.7±0.8) cm和(8.2±1.5) cm ,手术出血量分别为 (63.2±30.3) mL和(170.6±21.4) mL,术后引流量分别为 (22.1±10.7) mL和(80.2±20.3) mL,X线照射时间分别为 (26.1±3.7) s和(16.5±4.2) s,差异均有统计学意义 (t=23.680、25.902、22.651、15.343, P值均＜0.01) 。观察组和对照组患者术后1年VAS分别为(0.68±0.41)分和(1.95±0.64)分,ODI分别为7.29%±3.60%和12.70%±4.27%,差异均有统计学意义 (t=14.950、8.664,P值均＜0.01)。观察组的神经根损伤、硬膜囊撕裂、马尾神经损伤等并发症发生率分别为1.25%(1/80)、0、0,低于对照组的13.75%(11/80)、10.00(8/80)、11.25%(9/80),差异均有统计学意义(χ²=7.297、6.447、7.535, P值均＜0.05);而椎间植骨融合率100.00%(80/80)则高于对照组的83.75%(67/80),差异有统计学意义(χ²=12.057, P＜0.01)。结论显微镜辅助下MIS-TLIF微创手术治疗腰椎退变性疾病疗效好、安全性高,手术创伤小、术后恢复快,建议临床推广应用。

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	张永峰
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	罗卓荆
	闫铭

关键词 ：腰椎退变性疾病, 椎间孔椎间融合术, 显微外科手术

Abstract：Objective To assess the clinical effects and safety of microscope assisted minimal invasive surgery-transforaminal lumbar inter-body fusion(MIS-TLIF) in the treatment of lumbar degenerative disease. Methods From January 2016 to January 2017, 160 patients of lumbar degenerative disease were retrospectively analyzed. Eighty patients underwent TLIF (the control　group) and 80 patients underwent microscope assisted MIS-TLIF (the observation group). Clinical evaluation: visual analog scale(VAS), Oswestry disability index (ODI), blood loss, postoperative drainage, X-irradiate time, length of hospital stay and interbody fusion rate. Results The surgical incision length was (3.7±0.8) cm in the observation group and (8.2±1.5) cm in the control group. The blood loss was (63.2±30.3) mL in observation group and (170.6±21.4) mL in control group. The postoperative drainage flow was (22.1±10.7) mL in observation group and (80.2±20.3) mL in the control group. The X-ray exposure time was (26.1±3.7)s in observation group and(16.5±4.2)s in control group, There were all significant differences between the two groups(t=23.680, 25.902, 22.651, 15.343, all P values＜0.01). The VAS scores (0.68±0.41 vs. 1.95±0.64, t=14.950, P＜0.01) and the ODI (7.29%±3.60% vs. 12.70%±4.27%, t=8.664, P＜0.01) showed significant differences between the observation group and the control group at one year of follow-up.The incidence of complications in the observation group was lower than that in the control group(P＜0.05).The rate of intervertebral bone graft fusion in the observation group was higher than that in the control group(P＜0.01). Conclusions MIS-TLIF assisted by microscope is a safe and effective treatment for lumbar degenerative disease. Patients with this operation have less traumas and recover faster after operation. Microscope assisted TLIF is worthy of clinical promotion.

Key words： Lumbar degenerative disease Micrographic surgery Transforaminal lumbar interbody fusion Microsurgery

收稿日期: 2018-03-30

通讯作者: 闫明, Email: spineyanming@163.com

引用本文:

张永峰, 张世磊, 袁斌, 王哲, 罗卓荆, 闫铭. 显微镜辅助下经椎间孔椎间融合微创治疗腰椎退变性疾病的临床疗效比较[J]. 中华解剖与临床杂志, 2018, 23(3): 198-202.
Zhang Yongfeng, Zhang Shilei, Yuan Bin, Wang Zhe, Luo Zhuojing, Yan Ming. Clinical effects of microscope assisted minimal invasive surgery-transforaminal lumbar inter-body fusion in the treatment of lumbar degenerative disease. Chinese Journal of Anatomy and Clinics, 2018, 23(3): 198-202.

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http://www.cjac.com.cn/CN/10.3760/cma.j.issn.2095-7041.2018.03.005 或 http://www.cjac.com.cn/CN/Y2018/V23/I3/198

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